Complications in the Third Trimester

Editor’ Note: This article continues Katherine Marple’s series on pregnancy with diabetes as a complicating factor. For previous articles, enter her name in the search feature at the top right-hand of this website. The next installment, “Birthing Options,” will appear on December 30.

It’s true that the third trimester means that you are closer to holding your baby, so it should feel exciting. But, the third trimester was the most difficult time for me. I found myself constantly worrying over the progress of my baby and wondering how soon I could take her out of my uterus, both for her sake and for mine.

Especially for someone who has had type 1 diabetes for as long as I have, 13 years, pregnancy brings worries. Our placentas tend to begin deteriorating in the last ten weeks of pregnancy, and we are at increased risk of developing pre-eclampsia (toxemia).

During the third trimester you require more and more insulin, so you’ll notice right away if your placenta is deteriorating because your insulin requirements will drop very quickly. Around weeks 34 through 36, it’s typical for your insulin needs to stabilize. If it happens sooner than that during the third trimester, however, it warrants an ultrasound to ensure that your baby is still getting the nutrients from your placenta that she needs to grow.

I didn’t experience this complication during my pregnancy, but I learned from the online community of other pregnant type 1 women that some faced this symptom around week 32. Those women ended up delivering their babies via induction and sometimes emergency cesarean section at week 34. The good news is that after 32 weeks in the womb, babies have a fantastic recovery rate in the hospital and rarely have any long-term illnesses associated with being born too soon.

Between weeks 32 and 34, I began to notice symptoms of pre-eclampsia: The swelling in my ankles began to increase beyond that of a typical pregnant woman. I worked full time at a desk job and kept my feet elevated on a foot rest throughout the day. However, the measures that used to bring the swelling down after work, like lemon water, elevating my legs while reclining, full hydration, and cold compresses, no longer relieved my swollen ankles. I’d wake up in the morning so swollen that I’d hardly be able to bend my knees to walk. My thighs were literally twice their normal size.

While standing in the shower around week 34, I saw spots. They looked like lots of tiny stars twinkling and lasted for about a minute. By week 35, I was getting blisters on my calves and the tops of my feet because the skin was stretched by swelling to the point of nearly bursting. Despite the amount of fluids that I was drinking, I rarely urinated those last few weeks.

Swelling, reduced urination, and seeing spots are all symptoms of pre-eclampsia. I was seeing my OB/GYN and MFM team twice a week, so I kept them updated as my symptoms became more frequent. Because my blood pressure was still 110/70 or 120/80, my doctors sent me home with the warning that I should watch for a migraine and call them if any more symptoms appeared.

I was so uncomfortable and so worried about my baby’s health during those weeks. Pre-eclampsia can be fatal for both mother and child because the mother’s body literally becomes toxic. When I developed a migraine at 37 weeks, my husband drove me to the emergency room and I was admitted. My blood pressure was up to 180/90. The blood tests confirmed that I was pre-eclamptic, and I was scheduled for an induction the following day.

I feared that my baby wasn’t done developing, but was also concerned that my body was more of a risk to her than the outside world. I tried to take comfort in the knowledge that at least we were in the hospital, where there were lots of doctors around us to help. That last day of pregnancy, I learned the first rule of parenting: Expect the unexpected.

I will describe my thoughts on birthing options in my next article.

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